Comparison of effects between home visits with telephone calls and telephone calls only for transitional discharge support: a randomised controlled trial

BACKGROUND home visits and telephone calls are two often used approaches in transitional care but their differential effects are unknown. OBJECTIVE to examine the overall effects of a transitional care programme for discharged medical patients and the differential effects of telephone calls only. DESIGN randomised controlled trial. SETTING a regional hospital in Hong Kong. PARTICIPANTS patients discharged from medical units fitting the inclusion criteria (n = 610) were randomly assigned to: control ('control', n = 210), home visits with calls ('home', n = 196) and calls only ('call', n = 204). INTERVENTION the home groups received alternative home visits and calls and the call groups calls only for 4 weeks. The control group received two placebo calls. The nurse case manager was supported by nursing students in delivering the interventions. RESULTS the home visit group (after 4 weeks 10.7%, after 12 weeks 21.4%) and the call group (11.8, 20.6%) had lower readmission rates than the control group (17.6, 25.7%). Significance differences were detected in intention-to-treat (ITT) analysis for the home and intervention group (home and call combined) at 4 weeks. In the per-protocol analysis (PPA) results, significant differences were found in all groups at 4 weeks. There was significant improvement in quality of life, self-efficacy and satisfaction in both ITT and PPA for the study groups. CONCLUSIONS this study has found that bundled interventions involving both home visits and calls are more effective in reducing readmissions. Many of the transitional care programmes use all-qualified nurses, and this study reveals that a mixed skills model seems to bring about positive effects as well.